Ligament & Tendon Injuries

While athletes who participate in sports that involve running, jumping and changing direction are at higher risk, anyone can injury their ligaments and tendons. These injuries can occur suddenly or gradually develop over time. Either way, ligament and tendon conditions are painful and interfere with your quality of life.

What are the most common problems affecting foot and ankle ligament and tendons?

Achilles Tendonitis – As the largest tendon in the body, the Achilles tendon stretches from the calf to the heel bone. It can develop tendonitis due to repetitive stress to the region. Breakdown in the tendon can occur anywhere along the length of the tendon, but is often noted at the lower portion where the tendon attaches to the heel. A bone spur can also develop at the base of the heel. Patients have pain, stiffness, swelling and thickening at the site. If you hear a sudden pop in the back of your calf or heel, this could indicate a tendon rupture, which needs immediate attention.

Typically, your orthopaedic surgeon will recommend conservative treatment with rest, ice, non-steroidal anti-inflammatory medications, physical therapy, and perhaps orthotics to provide more support in your shoes. If your pain has not improved after six months, there are some procedures that may help repair your damaged Achilles tendon.

Gastrocnemius recession surgery – This minimally invasive procedure can be performed with or without debridement (removal of excess or damaged tissue). Your orthopaedic surgeon lengthens the calf muscle so that you will gain more motion in your ankle.

Debridement and repair – In cases where less than half of the tendon is damaged, your surgeon can remove the damaged section of tendon and any bone spurs that have developed. The tendon is secured to the heel with anchors.

Debridement with tendon transfer – In more severely damaged cases, the Achilles tendon can be removed and replaced with the tendon that is attached to the big toe. This does not disrupt the toes ability to move.

The time it takes to recover from these surgeries varies based on the extent of the injury and repair. In general, most patients are fully recovered after one year. During the months following surgery, patients have to rest their foot and undergo extensive physical therapy to ensure mobility.

Plantar Fasciitis and Bone Spurs – The band of tissue that runs along the bottom of your foot and supports you arch is called the plantar fascia. It is designed to handle a lot of stress and strain, but can sometimes become damaged due to tight muscles, obesity, repetitive activity and new exercise or sports. While an inflamed plantar fasciitis may also have heel or bone spurs, they rarely cause pain. The discomfort patients report is related to tears or damage to the actual tissue.

Patients diagnosed with plantar fasciitis often have pain in and around the heel with pain being more prevalent when they first get out of bed or up from sitting.

Your orthopaedic surgeon will first recommend nonsurgical therapy that includes rest, ice, medication to reduce pain and swelling, exercises (especially stretches) and sometimes injections, orthotics, night splints and physical therapy. Surgery is usually not performed, but if you cannot get relief after a year of conservative therapy, surgery may help relieve your symptoms. Two minimally invasive procedures are performed by orthopaedic surgeons on staff at WakeMed:

Gastrocnemius recession – This lengthening of the patient’s calf muscle helps relieve the pressure on the plantar fascia. During the surgery, one of two muscles in the calf is lengthened to help increase motion in the ankle.

Plantar fascia release – By cutting a portion of the plantar fascia ligament, tension is relieved in the heel, which decreases the patient’s pain. If a bone spur is present, it also can be removed at the time of surgery.

Recovery takes a few months, requiring patients to wear a supportive boot and undergo physical therapy and exercise to improve range of motion and restore strength to nearby muscles.

Posterior Tibial Tendon Dysfunction – This tendon, which attaches the calf muscles to the bones on the inside of the foot, is one of the most important tendons that holds up the arch and aids with walking. When it becomes damaged or inflamed, it can result in flatfoot. Patients can have pain inside the foot and ankle and have difficulty walking and standing at times. You can also have pain on the outside of the ankle since you may adjust your stance.

While traumatic injury can tear the tendon, it is more common for the condition to develop over time. Normally, it occurs from overuse in athletes who participate in high-impact sports and in those over age 40 who are overweight.

If diagnosed with posterior tibial tendon dysfunction, your orthopaedic surgeon will first recommend that you alter your activities that cause pain. Additionally, you may be prescribed medication to ease discomfort and swelling, treat with ice and even immobilize the foot in a walking boot for six to eight weeks to allow the tendon to rest. Your doctor may fit you for orthotics to give the arch added support and prescribe physical therapy. After six months, if you do not get relief, you may want to explore a surgical repair.

At WakeMed, our orthopaedic surgeons can perform procedures that lengthen the Achilles tendon, clear the tendon of inflamed tissue or even do a tendon transfer. Each surgery is done based on the type of injury and location of the tendonitis. Surgery is done only in extreme cases and has a recovery period of up to a year.